Forensic Aspects of Paediatric Fractures: Differentiating Accidental Trauma from Child Abuse

Foreword
Contents
1: Child Abuse, Non-Accidental Trauma, and Inflicted Injuries
1.1 Defining Child Abuse
1.1.1 Child Abuse
1.1.2 Physical Abuse
1.1.3 Neglect
1.1.4 Emotional/Psychological Abuse
1.1.5 Sexual Abuse
1.1.6 Fabricated or Induced Illness by Parents/Caregivers
1.2 Epidemiology
1.3 Clinical Aspects
1.4 Defining Trauma and Injury
1.5 Cause of Injury
1.5.1 Introduction
1.5.2 Mechanical Trauma
1.5.2.1 Static Loading
1.5.2.2 Dynamic Loading
1.5.3 Non-mechanical Trauma: Physical Agents
1.5.4 Direct and Underlying Cause
1.6 Manner of Injury
1.7 Cutaneous Injuries
1.7.1 Introduction
1.7.2 Blunt-force Trauma: Closed Skin Injuries
1.7.2.1 Erythema
1.7.2.2 Bruises
1.7.2.3 Petechiae
1.7.3 Blunt-force Trauma: Open Injuries
1.7.3.1 Abrasions
1.7.3.2 Lacerations and Avulsions
1.7.3.3 Blunt Penetrating Trauma
1.7.4 Sharp-force Trauma
1.7.4.1 Incisions and Stab Wounds
1.7.4.2 Gunshot Wound
1.7.5 Non-mechanical Trauma: Near Contact with Physical Agents
1.8 Other Injuries
1.8.1 Introduction
1.8.2 Thoracoabdominal Injuries
1.8.2.1 Intrathoracic Injuries
1.8.2.2 Intra-abdominal Injuries
1.9 Objectifying Suspicions of Inflicted Injuries and Non-accidental Trauma
1.10 Characteristics of the Clinical History
1.10.1 Clinical History
1.10.2 The Origin of the Injuries
1.10.3 Delay in Seeking Medical Help
1.10.4 Attitude and Reaction of the Parents/Caregivers
References
2: General Aspects of Fractures in Children
2.1 Introduction
2.1.1 Definition
2.1.2 Epidemiology
2.2 Diagnosis and Differential Diagnosis of Fractures in Children
2.2.1 Clinical Presentation
2.2.2 Differential Diagnosis
2.3 Fracture or Mimic
2.4 Fracture Description
2.4.1 Anatomic Location and Type of Bone
2.4.1.1 Identification of the Fractured Bone
2.4.1.2 Bone Type
Long Bones
Short Bones
Flat Bones
Sesamoid Bones
Irregular Bones
2.4.1.3 Affected Part of the Bone
2.4.2 Type of Fracture and Direction of Fracture Lines
2.4.3 Position and Relationship of the Fracture Components
2.4.4 Complications
2.5 Cause of Fractures (Mechanism)
2.5.1 General Aspects
2.5.2 High-Energy Trauma
2.5.3 Low-Energy Trauma
2.5.3.1 Low-Energy Trauma: Normal Sufficient Bone—Single Load
2.5.3.2 Low-Energy Trauma: Normal Sufficient Bone—Repeated Load
Avulsion Fractures
Fatigue Fractures in Normal Bone: Stress Fractures
2.5.3.3 Low-Energy Trauma: Normal Insufficient Bone
2.5.3.4 Low-Energy Trauma: Abnormal Bone
2.5.3.5 The Use of Terms like Spontaneous and Pathological Fractures in Forensic Paediatrics
2.6 Manner of Fractures (Circumstances)
2.6.1 Intrauterine Fractures
2.6.1.1 Intrauterine Fractures in Normal Bone
2.6.1.2 Intrauterine Fractures in Weakened Bone
2.6.2 Fractures During Birth: Birth Trauma
2.6.2.1 General Aspects of Birth Trauma-Related Fractures
2.6.2.2 Incidence and Prevalence of Fractures Resulting from Birth
2.6.3 Fractures After Birth: Accidental Circumstances
2.6.4 Fractures After Birth: Non-Accidental Circumstances
2.6.4.1 Epidemiology
2.6.4.2 Specificity of Fractures, Sustained in Non-Accidental Circumstances
2.6.4.3 The Value of Haematomas in the Differential Diagnosis Between Accidental and Non-accidental Circumstances
2.6.4.4 Perpetrators and Victims
2.6.5 Fractures After Birth: Other Circumstances
References
3: Radiology in Suspected Child Abuse
3.1 Introduction
3.2 Conventional Radiology
3.2.1 Guidelines
3.2.1.1 American College of Radiology
3.2.1.2 The Royal College of Radiologists and the Society and College of Radiographers
3.2.1.3 Examination on Indication
3.2.2 Adequacy of Examination
3.2.2.1 Number of Views
3.2.2.2 Technique
3.2.2.3 Technical Shortcomings in Making a Skeletal Survey
3.2.2.4 Follow-Up Skeletal Survey
3.3 Bone Scintigraphy
3.3.1 Effectivity of Bone Scintigraphy Versus Conventional Radiology
3.4 Computed Tomography
3.5 Linear Slot Scanning
3.6 Magnetic Resonance Imaging
3.7 Ultrasonography
3.8 Bone Densitometry
3.9 Post-Mortem Imaging
3.10 Radiation Dose in Imaging Suspected Child Abuse
References
Untitled
4: Fracture Dating
4.1 Introduction
4.2 Biology of Fracture Repair
4.2.1 Types of Fracture Repair
4.2.1.1 The Inflammatory Phase
4.2.1.2 The Reparative Phase
4.2.1.3 The Remodelling Phase
4.2.2 Factors that Influence Fracture Repair
4.2.2.1 Local Factors
4.2.2.2 Systemic Factors
4.3 Dating Fractures
4.3.1 Radiological Aspects of Fracture Dating
4.3.2 Histological Aspects of Fracture Dating
4.4 The Practice of Fracture Dating in Dutch Forensic Casework
4.4.1 Radiological Imaging Before and After Autopsy
4.4.2 Histological Analysis
4.4.3 Interpretation
4.4.4 Examples of Fracture Dating
References
5: Head
5.1 General Aspects of Head Injuries
5.1.1 Introduction
5.1.2 Injuries to the Scalp and the Bony Tissues of the Skull
5.1.3 Injuries to the Orofacial Soft Tissues and the Intracranial Content
5.2 Injuries of the Scalp
5.2.1 Introduction
5.2.1.1 Anatomy of the Scalp
5.2.1.2 Scalp Injuries
5.2.1.3 Cause and Manner of Scalp Injuries
5.2.1.4 Type and Severity of Scalp Injuries
5.2.2 Cutaneous and Subcutaneous Injuries of the Scalp
5.2.2.1 Introduction
5.2.2.2 Bruises
5.2.2.3 Abrasions, Lacerations, and Avulsions
General Aspects
Trauma After Birth: Accidental Circumstances
Trauma After Birth: Non-accidental Circumstances
5.2.2.4 Traction Alopecia
5.2.2.5 Scalp Injuries, Skull Fractures and Intracranial Injuries
5.2.3 Subgaleal Haematoma
5.2.3.1 Introduction
5.2.3.2 Cause of Subgaleal Haematoma
Traumatic Separation of the Galea from the Periosteum
Migration of Intracranial Blood and/or Liquor to the Subgaleal Space
5.2.3.3 Manner of Subgaleal Haematoma
Intrauterine Trauma
Trauma During Birth
Trauma After Birth: Accidental or Non-accidental
Accidental Traction
Accidental Impact Trauma/Blunt Force Trauma
Non-accidental Traction
Non-accidental Impact Trauma/Blunt Force Trauma
5.2.3.4 Differential Diagnosis of Subgaleal Haematoma
Other Scalp Haematomas
Coagulation Disorders
Other Disorders
The Use of Anticoagulants
5.2.3.5 Dating Subgaleal Haematomas
5.2.4 Cephalhaematoma
5.2.4.1 Introduction
5.2.4.2 Cause and Manner of Cephalhaematoma
5.3 Calvarium Fractures
5.3.1 Introduction
5.3.2 Cause of Calvarium Fractures
5.3.2.1 Static Loading
Defining Static Loading
Injuries to the Head in Static Loading
5.3.2.2 Dynamic Impact Loading
Defining Dynamic Impact Loading
Injuries to the Head in Dynamic Impact Loading
Child’s Versus Adult’s Calvarium in Dynamic Impact Loading
Deformation in Dynamic Impact Loading: Trauma-Related and Anatomy-Related Factors
Trauma-Related Factors: Location of the Impact
Trauma-Related Factors: Amount of Energy Transferred At the Impact
Anatomy-Related Factors: The Scalp
Anatomy-Related Factors: The Age of the Child
Anatomy-Related Factors: Shape, Build, and Thickness of the Skull
5.3.3 Manner of Calvarium Fractures
5.3.3.1 Trauma Before Birth
Trauma Before Birth Due to Static Loading
Trauma Before Birth Due to Dynamic Impact Loading
Trauma Before Birth Due to Dynamic Impact Loading: Accidental Circumstances
Trauma Before Birth Due to Dynamic Impact Loading: Non-accidental Circumstances
Disease-Related Intrauterine Calvarium Fractures
5.3.3.2 Trauma During Birth
Trauma During Birth Due to Static Loading
Disease-Related Calvarium Fractures Due to Trauma During Birth
5.3.3.3 Trauma After Birth: Static Loading
Accidental Circumstances
Non-accidental Circumstances
5.3.3.4 Trauma After Birth: Dynamic Impact Loading—Accidental Circumstances
Accidents: Falls
Accidental Short-Distance Falls
Uncomplicated Short-Distance Falls in Living Children
Experimental Uncomplicated Short-Distance Falls in Deceased Children
Complicated Short-Distance Falls
Falls from the Arms of Parent or Caregiver
Falls on Objects
Accidental Short- and Intermediate-Distance Falls
Falls from Furniture
Falls From or with Stroller
Falls from Baby Carriers, Bouncy Chairs, Baby Bouncers, and Car Seats
Falls from High Chairs
Falls from Shopping Carts
Falls from Bunk Beds
Falls During Playing and Sporting Activities
Accidental Long-Distance Falls
Long-Distance Free Falls and Falls From Windows, Balconies, and Rooftops
Long-Distance Falls from Playing Equipment
Long-Distance Falls from Stairs
Falls with Baby Walkers, Including Walker Falls from Stairs
Accidents: Toppling Televisions and Other Falling Heavy Objects
Accidental Circumstances: Traffic Accidents
Accidental Circumstances: Daily Activities
5.3.3.5 Trauma After Birth: Non-accidental Circumstances
Epidemiology
Differential Diagnosis, Based on Type of Calvarium Fractures
5.3.3.6 Medical Differential Diagnosis of Calvarium Fractures Due to Trauma After Birth
5.3.4 Types of Calvarium Fractures
5.3.4.1 Introduction
5.3.4.2 Simple (Single Line)/Linear or Curvilinear Calvarium Fractures
5.3.4.3 Symmetrical or Bilateral Linear Calvarium Fractures
5.3.4.4 Complex and Comminuted Calvarium Fractures
5.3.4.5 Complete and Incomplete Depressed Calvarium Fractures
5.3.4.6 Growing Fractures of the Calvarium
Introduction
Cause of Growing Fractures
Manner of Growing Fractures
Trauma Before Birth
Trauma During Birth
Trauma After Birth
5.3.4.7 Normal Variants Simulating Fractures
Sutures
Accessory Sutures
The Occipital Bone
The Parietal Bone
Fractures Versus Accessory Sutures
5.3.5 Calvarium Fractures and Intracranial Injuries
5.3.6 Dating of Calvarium Fractures
5.3.6.1 Soft Tissue Swelling
5.3.6.2 Radiological Characteristics
5.4 Basilar Fractures
5.4.1 Introduction
5.4.2 Cause and Manner of Basilar Fractures
5.4.3 Differential Diagnosis of Basilar Fractures
5.5 Orofacial Bone Fractures and Dental Trauma
5.5.1 Introduction
5.5.2 Cause of Orofacial Bone Fractures
5.5.3 Manner of Orofacial Bone Fractures
5.5.3.1 Accidental and Non-accidental Circumstances
5.5.3.2 Manner, Fracture Location, Gender, and Age of Sustaining
5.5.3.3 Manner and the Occurrence of Associated Injuries
5.5.4 Mandibular Fractures
5.5.4.1 Mandibular Fractures in Children Under the Age of 2 Years
Mandibular Fractures in the Neonatal Period
Mandibular Fractures Between 1 Month and 2 Years of Age
5.5.4.2 Mandibular Fractures in Children Above the Age of 2 Years
Mandibular Fractures in Children Between 2 and 12 Years of Age
Mandibular Fractures in Children Older than 12 Years of Age
5.5.5 Midfacial (Maxillary and Zygomatic Arch) Fractures
5.5.6 Orbital Fractures
5.5.6.1 General Aspects of Orbital Fractures
5.5.6.2 Orbital Rim Fractures
5.5.6.3 Orbital Floor Fractures
Direct Orbital Floor Fractures
Indirect Orbital Floor Fractures
5.5.6.4 Orbital Roof Fracture
5.5.6.5 Orbital Fractures Due to Trauma During Birth
5.5.6.6 Orbital Fractures Due to Trauma After Birth
General Aspects of Orbital Fractures Due to Trauma After Birth
Gender and Orbital Fractures Due to Trauma After Birth
Location of the Orbital Fractures and Age of Sustaining
5.5.7 Nasal Bone and Nasal Septum Fractures
5.5.8 Frontal Bone Fractures
5.5.9 Dental Trauma, Dental Neglect, and Gingival Injuries
5.5.9.1 Dental Trauma
Introduction
Cause and Manner of Dental Trauma
5.5.9.2 Dental Neglect
5.5.9.3 Gingival Injuries
5.6 Intracranial Injuries
5.6.1 Introduction
5.6.2 Trauma-Related Intracranial Findings
5.6.3 Cause of Trauma-Related Intracranial Findings
5.6.4 Manner of Trauma-Related Intracranial Injuries
5.6.4.1 Trauma-Related Intracranial Injuries Sustained During Birth
Subdural Haematoma
Retinal Haemorrhages
5.6.4.2 Trauma-Related Intracranial Injuries Sustained After Birth
5.6.4.3 Medical Conditions in the Differential Diagnosis of Physical Findings in Inflicted Head Trauma
5.6.5 Intracranial Injuries and Skull Fractures
5.6.5.1 General Aspects of Intracranial Injuries in Children with Skull Fractures
5.6.5.2 Intracranial Injuries in Children with Linear Skull Fractures
5.6.5.3 Intracranial Injuries in Children with Depressed Skull Fractures
References
6: Spine
6.1 General Aspects of Spinal Fractures
6.1.1 Clinical Presentation
6.1.2 Epidemiology
6.1.2.1 Age-Related Incidence and Male-to-Female Ratio
6.1.2.2 Location and Age-Related Level of Fractures
6.1.2.3 Cord Lesions and SCIWORA
6.1.2.4 Associated Injuries and Mortality
6.2 Cause of Spinal Fractures
6.3 Manner of Spinal Injuries
6.3.1 Trauma After Birth: Accidental Trauma
6.3.2 Trauma After Birth: Non-accidental Trauma
6.3.2.1 Clinical Aspects and Epidemiology
6.3.2.2 Non-accidental Spinal Injuries and Associated Injuries
6.3.2.3 Spinal Injuries in Fatally Abused Children
6.4 Cervical Spine Injuries
6.4.1 Specific Aspects of Cervical Spine Injuries
6.4.2 Manner of Cervical Spine Injuries
6.4.2.1 Trauma Before Birth
6.4.2.2 Trauma During Birth
6.4.2.3 Trauma After Birth: Accidental Circumstances
6.4.2.4 Trauma After Birth: Non-accidental Circumstances
Clinical Aspects and Epidemiology
Non-accidental Cervical Spine Injuries and Associated Injuries
6.5 Thoracolumbar Spine Injuries
6.5.1 Specific Aspects of Thoracolumbar Spine Injuries
6.5.2 Manner of Thoracolumbar Spine Injuries
6.5.2.1 Trauma Before Birth
6.5.2.2 Trauma During Birth
6.5.2.3 Trauma After Birth: Accidental Circumstances
6.5.2.4 Trauma After Birth: Non-accidental Circumstances
Fractures and Fracture Dislocations
Spinal Subdural and Epidural Haemorrhage
6.6 Injuries to the Sacrum and Coccyx
6.6.1 Specific Aspects of Injuries of the Sacrum and Coccyx
6.6.2 Manner of Injuries of the Sacrum and Coccyx
6.6.2.1 Trauma Before and During Birth
6.6.2.2 Trauma After Birth: Accidental Circumstances
6.6.2.3 Trauma After Birth: Non-accidental Circumstances
6.7 Differential Diagnosis
References
7: Ribs
7.1 General Aspects of Rib Fractures
7.2 Cause of Rib Fractures
7.2.1 Static Loading: Compression
7.2.2 Dynamic Impact Loading
7.3 Manner of Rib Fractures
7.3.1 Trauma Before Birth
7.3.2 Trauma During Birth
7.3.3 Trauma After Birth: Accidental and Non-accidental Circumstances
7.3.3.1 Epidemiology of Rib Fractures, Due to Trauma After Birth
7.3.3.2 Morbidity and Mortality Associated with Rib Fractures
7.3.3.3 Accidental Versus Non-accidental Rib Fractures
7.3.3.4 Non-accidental Rib Fractures
General Aspects of Non-accidental Rib Fractures
Posterior Rib Fractures
Fractures of the First Rib
Injuries to the Costochondral Junction
Rib Fractures as Indication for Respiratory Obstruction by Chest Compression
7.3.4 Trauma After Birth: Medical Procedures
7.3.4.1 Resuscitation and Rib Fractures
General Aspects of Resuscitation
Two-Finger Cardiopulmonary Resuscitation and Two-Thumb-Encircling Hands Chest Compression
Rib Fractures, Due to Resuscitation: Epidemiological Data
Rib Fractures, Due to Resuscitation: Concluding Remarks
Other Injuries, Due to Resuscitation
7.3.4.2 Physiotherapy, Chiropractic Care, and Rib Fractures
7.3.4.3 Surgical Interventions and Rib Fractures
7.3.5 Trauma after Birth: Medical Conditions
7.3.5.1 Rib Fractures in Preterm Children
7.3.5.2 Rib Fractures in Children with Bone Disease
Osteogenesis Imperfecta and Rib Fractures
Rickets and Rib Fractures
Menkes Disease and Rib Fractures
Metabolic Disturbances and Rib Fractures
Osteopetrosis and Rib Fractures
7.3.5.3 Rib Fractures in Serious Coughing Fits
7.3.5.4 Bone Disease: Concluding Remarks
7.4 Penetrating Chest Trauma
7.4.1 General Aspects of Penetrating Chest Trauma
7.4.2 Penetrating Chest Trauma: Accidental Circumstances
7.4.3 Penetrating Chest Trauma: Non-accidental Circumstances
7.4.3.1 Non-accidental Trauma at Home
7.4.3.2 Non-accidental Trauma outside the Home
7.4.3.3 Non-accidental Trauma in Conflicts and Wartime
7.5 Differential Diagnosis
References
8: Clavicle
8.1 General Aspects of Clavicle Fractures
8.2 Cause of Clavicle Fractures
8.2.1 Direct Trauma with High Energy Transfer
8.2.2 Indirect Trauma
8.3 Manner of Clavicle Fractures
8.3.1 Trauma Before Birth
8.3.2 Trauma During Birth
8.3.3 Trauma After Birth: Accidental Circumstances
8.3.4 Trauma After Birth: Iatrogenic
8.3.5 Trauma After Birth: Non-accidental Circumstances
8.4 Differential Diagnosis of Clavicle Fractures
References
9: Sternum
9.1 General Aspects of Sternum Fractures
9.2 Cause of Sternum Fractures
9.2.1 Direct Trauma
9.2.2 Indirect Trauma
9.2.2.1 Distortion
9.2.2.2 Fatigue Fractures in Normal Bone: Stress Fractures
9.2.2.3 Fatigue Fractures in Weakened Bone: Insufficiency Fractures
9.3 Manner of Sternum Fractures
9.3.1 Trauma After Birth: Accidental Circumstances
9.3.2 Trauma After Birth: Medical and Paramedical Procedures
9.3.3 Trauma After Birth: Non-accidental Circumstances
9.4 Differential Diagnosis of Sternum Fractures
9.4.1 Sternal Segment Dislocations
9.4.2 Self-limiting Sternal Tumour of Childhood
References
10: Scapula
10.1 General Aspects of Scapula Fractures
10.2 Cause of Scapula Fractures
10.2.1 Direct Trauma with High-energy Transfer
10.2.2 Indirect Trauma
10.2.3 Traction Trauma
10.2.4 Cause of Scapula Fractures on Specific Locations
10.3 Manner of Scapula Fractures
10.3.1 Trauma After Birth: Accidental Circumstances
10.3.2 Trauma After Birth: Medical and Paramedical Procedures
10.3.3 Trauma After Birth: Non-accidental Circumstances
10.4 Differential Diagnosis of Scapula Fractures
References
11: Pelvis
11.1 General Aspects of Pelvic Fractures
11.2 Cause of Pelvic Fractures
11.2.1 Direct Trauma with High-Energy Transfer
11.2.2 Indirect Trauma with Low(er) Energy Transfer: Overuse Fractures
11.2.2.1 Apophyseal Avulsion Fractures
11.2.2.2 Fatigue Fractures in Normal Bone: Stress Fractures
11.2.2.3 Fatigue Fractures in Weakened Bone: Insufficiency Fractures
11.3 Manner of Pelvic Fractures
11.3.1 Trauma After Birth: Accidental Circumstances
11.3.2 Trauma After Birth: Sporting Activities
11.3.2.1 Apophyseal Avulsion Fractures
11.3.2.2 Fatigue Fractures in Normal Bone: Stress Fractures
11.3.2.3 Trauma After Birth: Non-accidental Circumstances
11.4 Paediatric Versus Adult Pelvic Fractures
11.4.1 High-energy Trauma: Pelvis Ring Fractures
11.4.2 High-energy Trauma: Acetabulum Fractures
11.4.3 Lower Energy Trauma: Apophyseal Avulsion Fractures
11.5 Differential Diagnosis of Pelvic Fractures
References
12: Extremities
12.1 General Aspects of Fractures of the Extremities
12.2 Fractures of the Diaphysis
12.2.1 Cause of Fractures of the Diaphysis
12.2.2 Manner of Fractures of the Diaphysis
12.3 Fractures of the Metaphysis and Epiphysis
12.3.1 Introduction
12.3.2 Metaphyseal Corner Fracture
12.3.2.1 Introduction
12.3.2.2 Cause of Metaphyseal Corner Fractures
12.3.2.3 Manner of Metaphyseal Corner Fractures
12.3.2.4 Differential Diagnosis
12.3.3 Salter–Harris Fractures
12.3.3.1 Introduction
12.3.3.2 Cause of Salter–Harris Fractures
12.3.3.3 Manner of Salter–Harris Fractures
12.3.4 Epiphyseal Transitional Fractures
12.4 Humerus
12.4.1 General Aspects of Humerus Fractures
12.4.2 Fractures of the Proximal Humerus
12.4.2.1 General Aspects of Fractures of the Proximal Humerus
12.4.2.2 Cause and Manner of Fractures of the Proximal Humerus
During Birth
After Birth: Accidental and Non-accidental Circumstances
12.4.3 Fractures of the Humerus Shaft
12.4.3.1 General Aspects of Humeral Shaft Fractures
12.4.3.2 Cause and Manner of Humeral Shaft Fractures
Before Birth
During Birth
After Birth: Accidental or Non-accidental Circumstances
After Birth: The ‘Hymel manoeuvre’
After Birth: Underlying Medical Conditions
12.4.4 Fractures of the Distal Humerus
12.4.4.1 General Aspects of Fractures of the Distal Humerus
12.4.4.2 Supracondylar Fractures: Epidemiology, Cause, and Manner
12.4.4.3 Fractures of the Lateral Condyle: Epidemiology, Cause, and Manner
12.4.4.4 Fractures of the Medial Condyle: Epidemiology, Cause, and Manner
12.4.4.5 Fractures of the Medial Epicondyle: Epidemiology, Cause, and Manner
12.4.4.6 Transphyseal Fractures: Epidemiology, Cause, and Manner
12.4.4.7 Capitellum Fracture: Epidemiology, Cause, and Manner
12.5 Radius and Ulna
12.5.1 General Aspects of Fractures of the Radius and Ulna
12.5.2 Cause of Fractures of the Radius and Ulna
12.5.3 Manner of Fractures of the Radius and Ulna
12.5.3.1 Before Birth
12.5.3.2 During Birth
12.5.3.3 After Birth: Accidental Circumstances
12.5.3.4 After Birth: Non-accidental Circumstances
12.5.4 ‘Nursemaid’s Elbow’
12.5.4.1 General Aspects of the ‘Nursemaid’s elbow’
12.5.4.2 Cause and Manner of the ‘Nursemaid’s elbow’
12.6 Fractures of the Hand
12.6.1 General Aspects of Fractures of the Hand
12.6.2 Cause and Manner of Fractures of the Hand
12.7 Femur
12.7.1 General Aspects of Femur Fractures
12.7.2 Fractures of the Proximal Femur
12.7.2.1 General Aspects of Fractures of the Proximal Femur
12.7.2.2 Cause of Fractures of the Proximal Femur in Normal Bone
12.7.2.3 Manner of Fractures of the Proximal Femur
Before Birth
During Birth
After Birth: Accidental or Non-accidental Trauma
After Birth: Diseases with an Increased Risk of Fractures of the Proximal Femur
12.7.3 Fractures of the Femoral Shaft
12.7.3.1 General Aspects of Fractures of the Femoral Shaft
12.7.3.2 Cause of Fractures of the Femoral Shaft
12.7.3.3 Manner of Fractures of the Femoral Shaft
Before Birth
During Birth
After Birth: Accidental and Non-accidental Circumstances
After Birth: Differentiating Accidental from Non-accidental Circumstances
After Birth: Traditional Massage, Physiotherapy, and Medical Procedures
After Birth: Diseases with an Increased Risk of Femoral Shaft Fractures
12.7.4 Fractures of the Distal Femur
12.7.4.1 General Aspects of Fractures of the Distal Femur
12.7.4.2 Cause of Fractures of the Distal Femur
12.7.4.3 Manner of Fractures of the Distal Femur
Before Birth
During Birth
After Birth: Accidental or Non-accidental Trauma
After Birth: Diseases with an Increased Risk of Fractures of the Distal Femur
12.8 Tibia and Fibula
12.8.1 General Aspects of Fractures of the Tibia and Fibula
12.8.2 Cause of Fractures of the Tibia and Fibula
12.8.3 Manner of Fractures of the Tibia and Fibula
12.8.3.1 Before Birth
12.8.3.2 During Birth
12.8.3.3 After Birth: Accidental Circumstances
12.8.3.4 After Birth: Non-accidental Circumstances
12.9 Fractures of the Foot
12.9.1 General Aspects of Fractures of the Foot
12.9.2 Cause and Manner of Fractures of the Foot
12.10 Subperiosteal Haemorrhage and Periosteal Reaction
12.10.1 Traumatic Sub-periosteal Haemorrhage
12.10.2 Periosteum, Periosteal Reaction, and the Healing of Fractures
12.11 Growth Arrest Lines
12.11.1 General Aspects of Growth Arrest Lines
12.11.2 Growth Arrest Lines Due to Childhood Medical Conditions
12.11.3 Growth Arrest Lines Due to Non-organic Failure to Thrive
References
13: Accidental Trauma
13.1 Introduction
13.2 Birth Trauma
13.2.1 Introduction
13.2.2 Incidence and Prevalence of Fractures Resulting from Birth
13.2.3 Conclusion
13.3 Accidental Fractures
13.3.1 General Considerations
13.3.2 Short-Distance Fall, Serious Injuries, Hospital Admissions, and Death
13.3.2.1 Introduction
13.3.2.2 Data from Literature
13.3.2.3 Conclusions
13.3.3 Fall from a Considerable Height
13.3.3.1 Introduction
13.3.3.2 Data from Literature
13.3.3.3 Conclusions
13.3.4 Fall with Caretaker
13.3.4.1 Introduction
13.3.4.2 Conclusion
13.3.5 Falls Involving Objects
13.3.5.1 Bed or Couch
Introduction
Data from Literature
Conclusions
13.3.5.2 Bunk Bed
Introduction
Data from Literature
Conclusions
13.3.5.3 Pram
Introduction
Data from Literature
Conclusions
13.3.5.4 Infant Seating Device
Introduction
Bounce Chair Data from Literature
Car Seat Data from Literature
Conclusions
13.3.5.5 High Chair
Introduction
Data from the Literature
Conclusions
13.3.5.6 Baby Jumpers
Introduction
Data from Literature
Conclusions
13.3.5.7 Exersaucer
Introduction
Data from Literature
Conclusions
13.3.5.8 Baby Walker
Introduction
Data from Literature
Conclusions
13.3.5.9 Stair
Introduction
Data from Literature
Conclusions
13.3.5.10 Shopping Cart
Introduction
Data from Literature
Conclusions
13.3.5.11 Trampoline
Introduction
Data from Literature
Conclusions
13.4 Medical Procedures
13.4.1 Introduction
13.4.2 Medical Procedures
13.4.2.1 Physical Examination
13.4.2.2 Lines and Punctures
13.4.2.3 Orthopaedic Surgery in Clubfeet
13.4.2.4 Physiotherapy
13.5 Sports
13.5.1 Introduction
13.5.2 Data from Literature
13.5.2.1 Acute Fractures
13.5.2.2 Chronic Osseous Injuries (Stress Injuries)
References
14: Normal Variants, Congenital, and Acquired Disorders
14.1 Introduction
14.2 Normal Variants
14.2.1 Subperiosteal New-Bone Formation
14.2.2 Metaphyseal Variants
14.2.3 Variants of the Cortex
14.2.4 Accessory Growth Centres and Sutures
14.3 Osteogenesis Imperfecta
14.3.1 Introduction
14.3.2 Clinical Presentation
14.3.3 Additional Examinations
14.3.4 Osteogenesis Imperfecta and Non-accidental Trauma
14.4 Rickets
14.4.1 Introduction
14.4.2 Clinical History—Clinical Manifestations
14.4.3 Physical Examination
14.4.4 Biochemical Testing
14.4.5 Radiological Examination
14.4.6 Rickets and Non-accidental Trauma
14.5 Syndromes and Congenital Disorders
14.5.1 Introduction
14.5.2 Sickle Cell Anaemia
14.5.3 Alagille Syndrome
14.5.4 Duchenne Muscular Dystrophy
14.5.5 Congenital Pseudarthrosis
14.5.6 Caffey’s Disease
14.5.7 Menkes Disease
14.5.8 Pain Insensitivity in Spina Bifida
14.5.9 Congenital Pain Insensitivity
14.6 Skeletal Dysplasias
14.6.1 Introduction
14.6.2 Metaphyseal Chondroplasia Type Schmid
14.6.3 Spondylometaphyseal Dysplasia ‘Corner Fracture Type’
14.6.4 X-Linked Hypophosphatemia
14.7 Metabolic Disorders
14.7.1 Introduction
14.7.2 Osteopetrosis
14.7.3 Osteoporosis
14.7.4 Dysostosis Multiplex Congenita
14.7.5 Hypophosphatasia
14.8 Infectious Diseases
14.8.1 Introduction
14.8.2 Osteomyelitis
14.8.3 Chronic Relapsing Multifocal Osteomyelitis
14.8.4 Congenital Syphilis
14.9 Oncological Diseases
14.9.1 Introduction
14.9.2 Malignancies
14.9.2.1 Leukaemia
14.9.2.2 Ewing Sarcoma
14.9.3 Benign Diseases
14.9.3.1 Osteoid Osteoma
14.9.3.2 Bone Cysts
14.10 Medication-Related Abnormalities
14.10.1 Introduction
14.10.2 Corticosteroids
14.10.3 Methotrexate
14.10.4 Hypervitaminosis A
14.10.5 Prostaglandins
14.10.6 Bisphosphonates
14.11 Other Disorders
14.11.1 Blount’s Disease
14.11.2 Epilepsy
14.11.3 Vitamin C Deficiency
14.11.3.1 Vitamin C Deficiency and Suspected Non-accidental Trauma
14.11.4 Copper Deficiency
References
15: The Role of the Expert Witness and the Abuse of Differential Diagnoses in Court
15.1 Introduction
15.2 Expert Witness
15.2.1 Duties and Responsibilities of the Expert Witness
15.2.2 The Radiology Report in Court
15.2.3 Guidelines
15.2.4 The Expert Witness in Court: The Differential Diagnosis
15.3 Abuse of Existing Diseases in the Differential Diagnosis
15.3.1 Fractures, Bruises, and Non-Accidental Trauma
15.3.2 Vitamin D Deficiency: Rickets
15.3.2.1 Vitamin D Levels
15.3.2.2 The Keller and Barnes Commentary on Rickets Versus Child Abuse
15.3.2.3 Other Publications Concerning Rickets Versus Child Abuse
Court Case 1
Court Case 2
15.3.2.4 The Scientific Evidence Concerning Rickets Versus Child Abuse
15.3.3 Vitamin C Deficiency, Vaccinations, and Fractures
15.3.4 Ehlers–Danlos Syndrome
15.3.4.1 Ehlers–Danlos Syndrome and Suspected Non-Accidental Trauma
15.3.5 Copper Deficiency
15.4 Non-Existing Disease in the Differential Diagnosis
15.4.1 Temporary Brittle Bone Disease
References
16: The Use and Misuse of the Medical Literature
16.1 Introduction
16.2 Evidence-Based Medicine
16.3 Journals
16.3.1 Introduction
16.3.2 Editorial Boards and Editors
16.3.3 Journal Quality
16.4 Peer Review
16.5 Literature Appraisal
16.5.1 Materials and Methods
16.5.1.1 Study Designs
16.5.1.2 Methodological Pitfalls
16.5.2 References
16.6 Rhetorical Pitfalls
16.6.1 Association Is Not Causation
16.6.2 Hasty Generalizations
16.6.3 Argument from Ignorance (Argumentum Ad Ignorantiam)
16.7 Examples of Misuse of the Medical Literature
16.7.1 Hypoxia as a Cause for the Findings in AHT
16.7.2 The Absence of Any Published Support for AHT
16.8 Summary
References
17: Bayesian Interpretation of Paediatric Fractures
17.1 Introduction
17.2 Bayesian Statistics
17.2.1 Prior Probability of Abuse
17.2.2 Diagnostic Value
17.2.3 Posterior Probability of Abuse
17.3 Diagnostic Value
17.4 Conclusion
References